Heys S D, Eremin O
University Department of Surgery, Medical School, Foresterhill, Aberdeen, Scotland.
Surg Gynecol Obstet. 1992 Jun;174(6):533-40.
Involvement of RLN by tumor cells is a prognostic index of survival and a biologic indicator of more distant metastatic disease. In most solid tumors in humans, removing the draining lymph nodes seems to have little impact on survival, although it may be important in local control of disease. Although data from animal studies suggest that tumor draining RLN may have an important antitumor role (particularly in the early stage of tumor growth), there is a shortage of evidence in humans to substantiate such a supposition. At the time of operation, alterations in nodal microarchitecture with an expansion of T and B lymphocyte compartments is well documented. The findings of immunologic studies, however, reveal a general hyporeactivity, inappropriate humoral and cell mediated responses to antigens associated with tumors and a low or absent natural cytotoxicity. Failure of host defenses, possibly induced by tumors, may be responsible for progressive growth of tumor and spread of tumor to the RLN, resulting in dissemination of the tumor cells, establishment of metastatic deposits and concurrent growth of tumor in lymph nodes. Regional lymphatics may have an important antitumor role at the early stage of the development of a tumor (as yet unproved in humans). With progressive growth of tumor, the lymphatics are unlikely to be beneficial, not only because of a failure of nodal anticancer defenses, but because they provide a possible preferred biologic environment for tumor cell proliferation and an anatomic route for dissemination to distant tissues and organs.
肿瘤细胞累及喉返神经是生存的预后指标和更远处转移性疾病的生物学指标。在大多数人类实体瘤中，切除引流淋巴结似乎对生存影响不大，尽管它在疾病的局部控制中可能很重要。虽然动物研究数据表明肿瘤引流喉返神经可能具有重要的抗肿瘤作用（特别是在肿瘤生长的早期阶段），但在人类中缺乏证据来证实这一假设。手术时，淋巴结微结构的改变以及T和B淋巴细胞区室的扩大已有充分记录。然而，免疫学研究结果显示普遍存在反应性低下、对与肿瘤相关抗原的体液和细胞介导反应不当以及自然细胞毒性低或缺乏。宿主防御功能的失败，可能由肿瘤诱导，可能是肿瘤进行性生长和肿瘤扩散至喉返神经的原因，导致肿瘤细胞播散、转移灶形成以及肿瘤在淋巴结中的同时生长。区域淋巴管在肿瘤发展的早期阶段可能具有重要的抗肿瘤作用（在人类中尚未得到证实）。随着肿瘤的进行性生长，淋巴管不太可能有益，这不仅是因为淋巴结抗癌防御功能的失败，还因为它们为肿瘤细胞增殖提供了可能的优选生物学环境以及向远处组织和器官播散的解剖途径。
